- 01Medicare rates proposed up 35%-39% in 2027.
- 02Blue Cross NC/SC deals reach 8m members from Nov 1.
- 03US tests fell 13% amid shift to reimbursable patients.
Pacific Edge (ASX: PEB) has secured new US insurer contracts and flagged substantial proposed Medicare reimbursement increases as it works towards a recovery in its bladder cancer testing business.
The proposed 2027 Medicare rates would lift payments for Cxbladder Monitor by approximately 35% to US$1,026 and Cxbladder Triage by 39% to US$1,058, from US$760 each currently.
The preliminary rates remain subject to finalisation by the Centers for Medicare & Medicaid Services, with implementation proposed for 1 January 2027.
Meanwhile, Blue Cross Blue Shield plans in North and South Carolina will begin reimbursing Cxbladder Triage as an in-network service from 1 November, extending contracted access to nearly eight million members.
Pacific Edge also expects Novitas to finalise its Medicare local coverage determination for Cxbladder Triage and Triage Plus before the end of 2026, although Novitas controls the timing.
Agreed Payment Terms
The Blue Cross arrangements mark Pacific Edge’s first combination of favourable US commercial insurer medical policy and in-network contracting, establishing agreed payment terms rather than coverage policy alone.
The contracts follow favourable policy language developed by laboratory benefit manager Avalon Healthcare Solutions and are expected to improve claims processing, payment timing, and revenue per test.
However, the proposed Medicare price rises do not establish test coverage, which remains a separate decision from the reimbursement rate.
“The proposed pricing increases for Triage and Monitor, in-network contracting with Blue Cross plans, and continued progress with Triage Plus are encouraging signs that the building blocks for US commercial recovery are falling into place,” chief executive Dr Peter Meintjes said.
“US volumes continue to reflect our disciplined approach to spending and the transition towards reimbursable patients.”
Sales Shift Weighs
US commercial testing fell 13% to 2,867 tests in the second quarter of the 2027 financial year, from 3,296 in the preceding quarter, amid restrained spending and a shift towards potentially reimbursable patients.
Commercial volumes in Asia Pacific rose 3.7% to 1,201 tests from 1,158, while total laboratory throughput increased 2.7% to 5,258 tests as clinical study activity expanded.
The higher-margin Cxbladder Triage Plus accounted for 5.6% of US tests during the quarter, up from 0.8% previously, and reached 10.8% in September.
Pacific Edge is concentrating US sales resources on intermediate-risk patients with microscopic blood in their urine, including women assessed through specialist and other clinical practices.
It has also secured a five-year US$1.3 million blanket purchase agreement with a Veterans Administration facility in Marion, Illinois, for Cxbladder Triage Plus and Monitor testing.
Clinical Study Results
A concordance study with Southern California Permanente Medical Group completed enrolment of approximately 2,000 patients to compare Triage Plus with the existing Cxbladder Triage test in routine care.
The group is expected to analyse those results ahead of a future publication and potential transition to the newer test.
In New Zealand, a Canterbury study of 4,512 referrals found the median waiting time for specialist assessment fell by 14.8 days after introduction of a pathway incorporating Cxbladder Triage and imaging.
The same study identified a 15-day reduction in median waiting time to first operative bladder cancer treatment, fewer referrals and improved access outcomes for Māori patients, without eliminating existing inequities.
An Australian validation study involving 691 evaluable patients found a 74% test-negative rate for Triage Plus and has been accepted for peer-reviewed publication, adding evidence for potential broader clinical adoption.
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The ASX small-cap stories that matter, filed before 9am AEST. Curated by the Small Caps desk.